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Three-dimensional reconstructions of the epicardial contour of the left ventricle (LV, red) and right ventricle (RV, green) in end diastole (open net) and end systole (colored surface). The left ventricle has a cylinder shape with a piston-like movement of the base. The shape of the right ventricle is more complex and the motion of the base differs between the lateral wall and the septum. An online supplemental movie shows an animation of the epicardial movement of both ventricles.
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The total heart volume variation (THVV) during systole has been proposed to be caused by radial function of the ventricles, but definitive data for both ventricles have not been presented. Furthermore, the right ventricle (RV) has been suggested to have a greater longitudinal pumping component than the left ventricle (LV). Therefore, we aimed to co...
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Introduction
Pulmonary artery pressure (PAP) is increased and right ventricular (RV) function is well preserved in healthy subjects upon exposure to high altitude (HA). An increase in PAP may trigger notching of the right ventricular outflow tract Doppler flow velocity envelope (RVOT notch), which is associated with impaired RV function in patients...
Central venous pressure (CVP) is used almost universally to guide fluid therapy in hospitalized patients. Both historical and recent data suggest that this approach may be flawed.
A systematic review of the literature to determine the following: (1) the relationship between CVP and blood volume, (2) the ability of CVP to predict fluid responsivenes...
Right ventricular (RV) function is of interest in an array of cardiopulmonary diseases. First-pass radionuclide ventriculography (FP), gated blood-pool single photon emission tomography (GBPS) and cardiac magnetic resonance imaging (MRI) are three currently used non-invasive methods for evaluation of right-sided cardiac function. The aim of our stu...
Various automatic algorithms are now being developed to calculate left ventricular (LV) and right ventricular (RV) ejection fraction from tomographic radionuclide ventriculography. We tested the performance of 4 of these algorithms in estimating LV and RV volume and ejection fraction using a dynamic 4-chamber cardiac phantom.
We developed a realist...
Continuous ventricular volume measurement by the conductance method assumes a homogeneous electrical field dispersed throughout and contained within the ventricle. Because of dense trabeculation and complex geometry, right ventricular (RV) volume description by this method may be seriously compromised. This study sought to determine the accuracy an...
Citations
... Atrioventricular plane displacement and LV longitudinal shortening are the primary contributors to heart contraction, accounting for 60% of the LV stroke volume and 80% of the right ventricular (RV) stroke volume [6]. Since LV longitudinal shortening is the major contributor to LV stroke volume [3], alterations in AA elasticity and subsequently increased mechanical load on the LV may play an important role in heart failure, particularly in heart failure with preserved ejection fraction (HFpEF) where reduced longitudinal strain and the significant impairment of longitudinal LV systolic function is common [7][8][9][10][11][12][13]. ...
... Additionally, the apex of the pericardium is connected to the caudal sternum via the sterno-pericardial ligament, interlinking the caudal sternum with the LV apex. This creates a relatively straight line of force between the stationary LV apex [6] at the caudal end and the aortic arch [4] at the cranial end with the aortic root in between that propels up and down by (16.4 ± 0.5 mm) during the cardiac cycle, when the LV shortens and the AA gets stretched [3,6]. Consequently, stiffening of the AA is expected to negatively affect this line of force reaching from the epicardial apex to the AA [29]. ...
... Additionally, the apex of the pericardium is connected to the caudal sternum via the sterno-pericardial ligament, interlinking the caudal sternum with the LV apex. This creates a relatively straight line of force between the stationary LV apex [6] at the caudal end and the aortic arch [4] at the cranial end with the aortic root in between that propels up and down by (16.4 ± 0.5 mm) during the cardiac cycle, when the LV shortens and the AA gets stretched [3,6]. Consequently, stiffening of the AA is expected to negatively affect this line of force reaching from the epicardial apex to the AA [29]. ...
During systole, longitudinal shortening of the left ventricle (LV) displaces the aortic root toward the apex of the heart and stretches the ascending aorta (AA). An in silico study (Living Left Heart Human Model, Dassault Systèmes Simulia Corporation) demonstrated that stiffening of the AA affects myocardial stress and LV strain patterns. With AA stiffening, myofiber stress increased overall in the LV, with particularly high-stress areas at the septum. The most pronounced reduction in strain was noted along the septal longitudinal region. The pressure–volume loops showed that AA stiffening caused a deterioration in LV function, with increased end-systolic volume, reduced systolic LV pressure, decreased stroke volume and effective stroke work, but elevated end-diastolic pressure. An increase in myofiber contractility indicated that stroke volume and effective stroke work could be recovered, with an increase in LV end-systolic pressure and a decrease in end-diastolic pressure. Longitudinal and radial strains remained reduced, but circumferential strains increased over baseline, compensating for lost longitudinal LV function. Myofiber stress increased overall, with the most dramatic increase in the septal region and the LV apex. We demonstrate a direct mechanical pathophysiologic link between stiff AA and reduced longitudinal left ventricular strain which are common in patients with HFpEF.
... Research indicates that atrioventricular plane displacement and LV longitudinal shortening are the primary contributor to heart pumping, accounting for 60% of the LV stroke volume and 80% of the right ventricular (RV) stroke volume [1]. Since LV longitudinal shortening is the major contributor to heart's stroke volume [2] any alterations in AA elasticity and the subsequently increase in mechanical load on the LV may play an relevant role in heart failure, particularly for heart failure with preserved ejection fraction (HFpEF). ...
... Throughout the cardiac cycle, the heart's epicardial apex remains stationary within the fluidtight pericardial sac, [1] which is anchored to the diaphragm. The pericardial sac's apex is also connected to the caudal sternum by the sterno-pericardial ligament, effectively linking the caudal sternum to the LV-apex. ...
Left ventricular (LV) longitudinal function is mechanically coupled to the elasticity of the ascending aorta (AA). The pathophysiologic link between stiff AA and reduced longitudinal strain and subsequent deterioration in longitudinal LV systolic function is likely relevant in heart failure with preserved ejection fraction (HFpEF). A proposed therapeutic effect of freeing the LV apex and allowing for LV inverse longitudinal shortening was studied in-silico utilizing Living Left Heart Human Model (Dassault Systémes Simulia Corporation). LV function was evaluated in a model with A) Elastic AA; B) Stiff AA; and C) Stiff AA with free LV apex. The cardiac model simulation demonstrated that freeing the apex caused inverse LV longitudinal shortening that can abolish the deleterious mechanical effect of a stiff AA on LV function. A stiff AA and impairment of LV longitudinal strain are common in patients HFpEF. The hypothesis-generating model strongly suggests that freeing the apex and inverse longitudinal shortening may improve LV function in HFpEF patients with a stiff AA.
... Unlike these parameters, speckle tracking strain measurement overcomes many of the limitations of the traditional methods, mainly because it is angle-independent. RVFWS provides rapid quantification of systolic longitudinal function, which generates 80% of the RV stroke volume [18], hence, represents a better estimate of global RV function. Nevertheless, it has been shown to detect subtle alterations and early deterioration of longitudinal systolic function before conventional parameters [11,19] and has been evaluated in patients with pulmonary sclerosis and normal pulmonary pressure [20]. ...
... It is well known however, that RVFWS values are significantly higher than RVGLS that includes the septum [12]. Because the septum shares myocardial tissue between the RV and LV, it is suggested that RVFWS is the best estimate of RV systolic function and better correlates with RV stroke volume [13,18]. ...
Longitudinal right ventricular free wall strain (RVFWS) has been identified as an independent prognostic marker in patients with pulmonary hypertension. Little is known however about the prognostic value of RVFWS in patients with sickle cell (SC) disease, particularly during exercise. We therefore examined the prognostic significance of RVFWS both at rest and with exercise in patients with SC disease and normal resting systolic pulmonary artery pressure (SPAP). Consecutive patients with SC disease referred for bicycle ergometer stress echocardiography (SE) were enrolled ftom July 2019 to January 2021. All patients had measurable tricuspid regurgitation velocity (TRV). Conventional echocardiography parameters, left ventricular global longitudinal strain (LVGLS), RVFWS, and ventriculoarterial coupling indices (TAPSE/SPAP and RVFWS/SPAP) were assessed at rest and peak exercise. Repeat SE was performed at a median follow-up of 2 years. The cohort consisted of 87 patients (mean age was 31 ± 11 years, 66% females). All patients had normal resting TRV < 2.8 m/s, RVFWS and LVGLS at baseline. There were 23 (26%) patients who had peak stress RVFWS < 20%. They had higher resting and peak stress TRV and SPAP, but lower resting and peak stress TAPSE/SPAP, RVFWS/SPAP, and LVGLS as well as lower peak stress cardiac output when compared to patients with peak stress RVFWS ≥ 20% (p < 0.05). Patients with baseline peak stress RVFWS < 20% had a significant decrease in exercise performance at follow-up (7.5 ± 2.7 min at baseline vs. 5.5 ± 2.8 min at follow-up, p < 0.001). In the multivariate analysis, baseline peak stress RVFWS was the only independent predictor of poorer exercise performance at follow-up [odds ratio 8.2 (1.2, 56.0), p = 0.033]. Among patients with SC disease who underwent bicycle ergometer SE, a decreased baseline value of RVFWS at peak stress predicted poorer exercise time at follow-up.
... The function of the left ventricle involves a complex interaction between different groups of muscle fibers oriented in various directions, including longitudinally, obliquely, and circumferentially. This results in a combination of the ventricle shortening in a circumferential manner, thickening of the heart wall in a radial direction, and shortening along its long axis [1,2]. Research has shown that the displacement of the atrio-ventricular plane along the long axis is a significant factor in the pumping action of the left ventricle in healthy individuals as well as in those with diseased hearts. ...
... Firstly, it helps with ventricular ejection by decreasing the size of the long axis left ventricle cavity. Secondly, during early diastole, the energy stored during systole creates suction in the ventricle, which is crucial for quick filling of the ventricle at low pressures in a healthy heart [2,34]. The assessment of left ventricular long axis function using echocardiography has demonstrated its predictive value for negative cardiovascular outcomes in various conditions, such as atrial fibrillation, post-myocardial infarction, heart failure, and tetralogy of Fallot [35]. ...
Introduction: In this study, we aimed to evaluate the possibility of assessing cardiac abnormality using the left ventricular anatomical axis (LVAA) obtained from short-axis views of myocardial perfusion imaging (MPI). Methods: To obtain LVAA, an ellipse was drawn around the outer wall of SPECT images from XCAT phantoms and patients. The best line was then drawn from the center of all the ellipses in the short-axis views called LVAA. Then, we defined two angles based on LVAA including Ɵ which is the angle created by LVAA with the x-axis, and Φ which is the angle created by LVAA with the z-axis. Results: In this study, 94 cases were enrolled including 48 males (51%) and 46 females (49%) with a mean age of 65.6510.04. According to the results, there was a significant difference between the two obtained angles and the result of the scan (p<0.05). The ideal cutoff of Ɵ for an abnormal scan was 91.79 (AUC, 0.93; p=0.001) with the sensitivity of 98% and specificity of 80%. Conclusion: It can be concluded that LVAA as a quantitative factor is significantly different between normal and abnormal MPS and can be used for the evaluation of MPI.
... The increased pressure can overload the right ventricle in SLE patients, thus inducing right ventricular remodeling. The right ventricular myocardium is mainly composed of the epicardial ring myocardium and the longitudinal endocardial myocardium, while the longitudinal myocardium plays a major role in the contraction and diastole of the right ventricle [22], accounting for approximately 80% of RV function [23]. In PAH patients early in the disease, the right ventricle adapts to the increased afterload by increasing contractility, and the right ventricular wall gradually thickens. ...
Pulmonary arterial hypertension (PAH) is a common complication of systemic lupus erythematosus (SLE), and PAH can cause right ventricle (RV) remodel and dyssynchrony. The aim of this study was to explore the value of RV dyssynchrony in predicting adverse clinical events in patients with systemic lupus erythematosus-aaociated pulmonary arterial hypertension (SLE-PAH) using two-dimensional speckle tracking echocardiography (2D-STE). A total of 53 patients with SLE-PAH were enrolled in this study. The dyssynchrony of the RV (RV-SD6) was evaluated by 2D-STE. The clinical data of all participants were collected, and routine cardiac function parameters were measured by two-dimensional echocardiography, and analyzed for their correlation with RV-SD6. The predictive value of RV-SD6 in clinical adverse event was evaluated. RV-SD6 was negatively correlated with RV-FLS, RV-FAC, and TAPSE (r = − 0.788, r = − 0.363 and r = − 0.325, respectively, all P < 0.01), while the correlation with RV-FLS was the strongest. linear regression analysis showed that RV-FLS was an independent risk factor for RV-SD6 (β = − 1.40, 95% CI − 1.65 ~ − 1.14, P < 0.001). Cox regression analysis showed that RV-SD6 was a predictor with clinical adverse events (HR = 1.03, 95% CI 1 ~ 1.06, P < 0.05). RV-SD6 was highly discriminative in predicting clinical adverse events (AUC = 0.764), at a cutoff of 51.10 ms with a sensitivity of 83.3% and specificity of 68.3%. RV-FLS was negatively correlated with RV-SD6 and was an independent risk factor for it. RV-SD6 can serve as an indicator for predicting the occurrence of adverse clinical events in SLE-PAH patients, with high sensitivity and specificity.
... There was no systematic deviation from the Bland-Altman plot (Fig. 5B). [12,21,22]. In addition, experiments in animal models demonstrated that the motility of the mitral annulus was significantly reduced when myocardial ischemia was present [23], which provided the preliminary basis for the prognostic evaluation of MAPSE in patients with MI. [15,24]. ...
To explore the predictive value of mitral annular plane systolic excursion (MAPSE) derived by cardiac magnetic resonance (CMR) for major adverse cardiovascular events (MACE) in postmyocardial infarction (MI) patients. Patients with MI who underwent 3.0 T CMR (Chinese Clinical Trial Registry, ChiCTR2200055158) were recruited retrospectively. CMR parameters included MAPSE and LVEF. Patients were followed up for MACE for more than 6 months and were separated into a No-MACE group and a MACE group. A total of 165 post-MI patients were included, and 103 patients were finally analyzed (61 patients belonged to the No-MACE group, and 42 patients belonged to the MACE group). The LVEF and MAPSE of the patients belonging to the No-MACE group were considerably higher than those of the patients belonging to the MACE group. Both LVEF and MAPSE were effective indicators of the occurrence of MACE after MI. The risk of MACE decreased as LVEF and MAPSE increased. For the risk prediction of MACE after MI, compared with model I (chi-square value 4.0 vs. 31.4, P < 0.001) and model II (chi-square value 22.7 vs. 31.4, P = 0.003), model III had a significant incremental predictive value. Moreover, the cutoff value of MAPSE was 9.70 mm. CMR-derived MAPSE is an effective predictor of MACE occurrence in patients with MI, and MAPSE provided a significant incremental predictive value. Moreover, MAPSE could complement LVEF for superior risk stratification of MI patients.
... ECG can not measure the right ventricular systolic function due to the irregular morphology of the right ventricle. The study of Carlsson et al. [14] reported that the right ventricular longitudinal strain contributed to approximately 75% of the right ventricular systolic function. The longitudinal displacement of the right ventricle, i.e., the systolic displacement of the tricuspid annulus toward the apex, could be used as an index to assess the right ventricular systolic function. ...
Purpose: To explore the myocardial protective effect of ozonated autohemotherapy (OA) during the progression of acute traumatic brain injury (TBI).
Methods: Forty patients with acute TBI were recruited and divided into The treatment group (Group OA, n = 20) and the Control group (Group C, n = 20). Patients in Group OA received OA before surgery and on the 1st and 2nd postoperative days, while patients in Group C underwent autologous blood transfusion. Venous blood was collected from all patients before (T0) and after 7 (T1) days of surgery for measurement of cardiac troponin T (cTnT) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP). At T0 and T1, transthoracic cardiac ultrasound was performed to measure left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and venous blood was sampled to determine the contents of superoxide dismutase (SOD) and malondialdehyde (MDA). NIH Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores were calculated, and other clinical indexes were recorded.
Results: (1) The levels of cTnT at T1 were significantly higher as compared with that at T0 in both groups (P < 0.000). Compared with Group C, a remarkable decline in the content of NT-proBNP was found in Group OA at T1 (P = 0.004). (2) The LVEF (P = 0.01) and serum SOD (P = 0.011) at T1 were significantly increased in Group OA as compared with those in Group C. (3) The length of ICU stay for patients in Group OA was distinctly shorter than that for patients in Group C (P = 0.011).
Conclusion: Perioperative OA treatment can alleviate the secondary myocardial injury during the disease course of TBI, which might be associated with its myocardial protective effect against oxidative stress.
... since the subendocardial longitudinal myocardium controls right ventricular motion, systole in the right ventricle is accomplished mostly through longitudinal contraction [8,9]. Research suggests that longitudinal motion accounts for 80% of the volume of a right ventricular stroke [10]. systolic function of the right ventricle is reflected in taPse and tricuspid annulus velocities. ...
Objective: To realize the changes in pulmonary hypertension (PH) patients’ right ventricular function.Methods: A total number of 74 patients with PH were included, and the parameters of standard echocardiographic were measured as well as the strain of peak longitudinal of each segment during the systole of the right ventricle to calculate the global longitudinal strain (LS) during systole of the right ventricular free wall.Results: ① As pulmonary arterial pressure increased, the right ventricular area gradually increased, and the case group showed the decreased right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid annular peak systolic velocity (S’) (p < 0.05). They, RVFAC, and TAPSE depicted significant differences that were statistical (p < 0.05) from the other groups. ② With increasing pulmonary arterial pressure, the right ventricular free wall’s LS gradually reduced (p < 0.05).Conclusion: ① LS right ventricular free wall is useful in detecting changes in right ventricular systolic function early on with greater sensitivity than RVFAC, TAPSE, and S’. In addition, increased right ventricular pressure loading can result in a subsequent impairment of right ventricular myocardial mechanics. ② As right ventricular pressure loading increases, right ventricular strain decreases. ③ In mild PH, the right ventricular free wall’s. LS is more sensitive than standard measures in spotting early alterations in myocardial mechanics.
... The increased pressure can overload the right ventricle in SLE patients, thus inducing right ventricular remodeling. The right ventricular myocardium is mainly composed of the epicardial ring myocardium and the longitudinal endocardial myocardium, while the longitudinal myocardium plays a major role in the contraction and diastole of the right ventricle [22], accounting for approximately 80% of RV function [23]. In PAH patients early in the disease, the right ventricle adapts to the increased afterload by increasing contractility, and the right ventricular wall gradually thickens. ...
Purpose
Pulmonary arterial hypertension (PAH) is a common complication of systemic lupus erythematosus (SLE), and PAH can cause right ventricle (RV) remodel and dyssynchrony. The aim of this study was to explore the value of RV dyssynchrony in predicting adverse clinical events in patients with systemic lupus erythematosus-aaociated pulmonary arterial hypertension (SLE-PAH) using two-dimensional speckle tracking echocardiography (2D-STE).
Methods
A total of 53 patients with SLE-PAH were assigned to an adverse clinical event group and a non-adverse clinical event group. The dyssynchrony of the RV (RV-SD6) was evaluated by 2D-STE. The clinical data of all participants were collected, and routine cardiac function parameters were measured by two-dimensional echocardiography, and analyzed for their correlation with RV-SD6. The predictive value of RV-SD6 in clinical adverse event was evaluated.
Results
RV-SD6 was negatively correlated with RV-FLS, RV-FAC, and TAPSE (r=-0.788, r=-0.363 and r=-0.325, respectively, all P < 0.01), while the correlation with RV-FLS was the strongest. linear regression analysis showed that RV-FLS was an independent risk factor for RV-SD6 (β=-1.40, 95% CI -1.65 ~ -1.14, P < 0.001). Cox regression analysis showed that RV-SD6 was independently associated with clinical adverse events (HR = 1.03, 95% CI 1 ~ 1.06, P < 0.05). RV-SD6 was highly discriminative in predicting clinical adverse events (AUC = 0.764), at a cutoff of 51.10 ms with a sensitivity of 83.3% and specificity of 68.3%.
Conclusion
RV-FLS was negatively correlated with RV-SD6 and was an independent risk factor for it. RV-SD6 can serve as an indicator for predicting the occurrence of adverse clinical events in SLE-PAH patients, with high sensitivity and specificity.
... Strain is calculated for each segment of the left ventricle (regional strains), and the mean of these measurements is the GLS of the LV [14]. Despite the LV strain being more commonly used in clinical practice, the measurement of the right ventricle (RV) longitudinal strain is a reliable method, and it is possible to calculate the global strain and the RV free wall strain [15]. ...
To measure left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography in idiopathic inflammatory myopathy (IIM) patients and to determine whether the LV GLS predicts outcomes in those patients. Prospective study consisted of a cross-sectional phase with 61 IIM patients and 32 individuals without IIM and longitudinal phase, in which patients were divided into two subgroups: 26 with reduced LV GLS and 35 with normal LV GLS; patients were followed for a mean of 25 months, and the occurrence of cardiovascular events and criteria for IIM activity were compared. The mean LV GLS (18.5 ± 2.9% vs. 21.6 ± 2.5%; p < 0.001) and right ventricle free wall strain (21.9 ± 6.1% vs. 27.5 ± 4.7%; p < 0.001) were lower in patients than in controls. The mean N-terminal pro B-type natriuretic peptide level was higher in patients than in controls. There were no differences regarding other cardiac involvement. Anti-Jo1 antibody was associated with general electrocardiographic abnormality and LV diastolic dysfunction. The subgroup with reduced GLS progressed with higher mean creatine phosphokinase, myositis disease activity assessment visual analogue scales, the physician’s and patient’s visual analogue scales, the health assessment questionnaire, and a higher proportion of relapses than the subgroup with normal GLS. There was no difference between the subgroups regarding cardiovascular events. The LV GLS appears to be useful for evaluating patients with IIM. Abnormal values are associated with more frequent relapses and increased disease activity during follow-up.
